Differential Diagnosis of Chest Pain in Pregnancy
When evaluating chest pain in pregnancy, it's crucial to consider a wide range of potential causes due to the physiological changes and increased risk of certain conditions during this period. The differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Musculoskeletal chest pain: This is often the most common cause of chest pain in pregnancy, attributed to the stretching of the chest wall and the musculoskeletal system to accommodate the growing fetus. The pain is typically sharp, localized, and worsens with movement or deep breathing.
Other Likely Diagnoses
- Gastroesophageal reflux disease (GERD): Pregnancy increases the risk of GERD due to relaxation of the lower esophageal sphincter and increased intra-abdominal pressure, leading to heartburn and chest discomfort.
- Pulmonary embolism (PE): Although less common, pregnancy increases the risk of venous thromboembolism, including PE, due to hypercoagulability, venous stasis, and vascular wall injury.
- Pneumonia: Pregnant women are at higher risk for respiratory infections, which can cause chest pain.
- Asthma: Exacerbations of asthma can occur during pregnancy and cause chest pain.
Do Not Miss Diagnoses
- Myocardial infarction (MI): Although rare in young pregnant women, MI can occur, especially with underlying cardiovascular risk factors. It's critical to consider this diagnosis due to its high mortality rate if untreated.
- Aortic dissection: This is a life-threatening condition that can be associated with pregnancy, particularly in women with pre-existing hypertension or connective tissue disorders like Marfan syndrome.
- Pulmonary hypertension: This condition can worsen during pregnancy and lead to right heart failure, presenting with chest pain among other symptoms.
- Spontaneous coronary artery dissection (SCAD): This is a rare cause of MI that is more common in women, especially during the postpartum period.
Rare Diagnoses
- Pericarditis: Inflammation of the pericardium can cause sharp chest pain that improves with leaning forward.
- Esophageal rupture or perforation: A rare but serious condition that can occur during pregnancy, often associated with severe vomiting or forceful contractions during labor.
- Pneumothorax: Although uncommon, pneumothorax can occur in pregnancy, particularly in women with underlying lung disease.
- Cardiac sarcoidosis: A rare condition where granulomatous inflammation affects the heart, potentially leading to chest pain, arrhythmias, and heart failure.